Document Detail

Referral letters for 2-week wait suspected colorectal cancer do not allow a 'straight-to-test' pathway.
MedLine Citation:
PMID:  19102819     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Some clinicians have argued that 2-week wait suspected colorectal cancer patients can go 'straight-to-test' to facilitate time to diagnosis and treatment. The aim of this study was to evaluate whether the currently used referral letters are reliable enough to allow that pathway. PATIENTS AND METHODS: General practitioner (GP) letters referring patients under the Two Week-Wait Rule for suspected colorectal cancer were prospectively reviewed over a 6-month period. Three examining consultants were asked to outline the tests they would perform having only read the letter, and then again after a clinical consultation with the patient. The outcome of these tests was tracked. RESULTS: A total of 217 referral letters of patients referred under Two Week Wait Rule for suspected colorectal cancer were studied. Having just read the referral letter, the most frequently requested test was colonoscopy (148), then CT scan (48), barium enema (44), followed by gastroscopy (23) and flexible sigmoidoscopy in 15 patients (some patients would have had more than one test requested). After consultation with the patients, tests requested as guided by the GP letter were changed in 67 patients (31%), where 142 colonoscopies, 61 CT scans, 37 barium enemas, 23 flexible sigmoidoscopies and 19 gastroscopies were organised. The referral indication which had tests changed most often was definite palpable rectal mass (67%), while patients referred with definite palpable right-sided abdominal mass had their tests least often changed (9%). A total of 22 patients were found to have colorectal cancers (10%) and 30 patients were diagnosed with polyps (14%). Out of 142 colonoscopies performed, 19 (13%) showed some pathology beyond the sigmoid colon and of the 23 patients who had flexible sigmoidoscopy initially, only three went on to have colonoscopy subsequently. During the 6-month period of the study, only five breaches of the waiting time targets were recorded (1 to the 31-day target and 4 to the 62-day target). CONCLUSIONS: A significant number of patients would have had tests changed after a clinical consultation. However, only a small number required further investigations having had a consultation prior to their initial investigations. We conclude that 2-week wait suspected colorectal cancer patients should be seen in the clinic first and should not proceed 'straight-to-test'.
M M Aljarabah; N R Borley; A J Goodman; J M D Wheeler
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Publication Detail:
Type:  Journal Article     Date:  2008-12-19
Journal Detail:
Title:  Annals of the Royal College of Surgeons of England     Volume:  91     ISSN:  1478-7083     ISO Abbreviation:  Ann R Coll Surg Engl     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-25     Completed Date:  2009-07-07     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  7506860     Medline TA:  Ann R Coll Surg Engl     Country:  England    
Other Details:
Languages:  eng     Pagination:  106-9     Citation Subset:  IM    
Department of Gastrointestinal Surgery, Cheltenham General Hospital, Cheltenham, UK.
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MeSH Terms
Aged, 80 and over
Colorectal Neoplasms / therapy*
Diagnostic Tests, Routine / statistics & numerical data
Middle Aged
Prospective Studies
Referral and Consultation / organization & administration*,  statistics & numerical data
Risk Factors
Time Factors
Waiting Lists*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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